/ Application to review infringement
Please do not complete this application if you are nominating the driver of the vehicle for a parking infringement. Refer to the Operator Owner Onus Form which was enclosed with the infringement.
Please print clearly. Fields marked with an asterisk (*) are mandatory and must be completed
Applicant details
Surname * / Name/s *
Business details ABN
ACN
Business / Company name
Street address *
Town * / Postcode *
Postal address *
Town * / Postcode *
Please provide at least one phone number and include the area code *
Telephone - business hours
Telephone - after hours
Mobile
Email
The person named in the infringement notice, or a person acting on his or her behalf, may apply to Gannawarra Shire Council to have the decision to issue this notice reviewed. An application must be in writing and must provide full details and particulars and should be forwarded to: Gannawarra Shire Council, PO Box 287 Kerang VIC 3579 before the expiry of the specified due date, as shown on the Penalty Infringement Notice. An infringement will only be waived on the following grounds:
  • there was a defect or mistake in the decision to serve the notice which includes:
  • the decision to issue the notice was contrary to law; or
  • there was a mistake of identity; or
  • that special circumstances apply to the person; or
  • the conduct for which the infringement notice was served should be excused having regard to
any exceptional circumstances relating to the infringement offence.
Gannawarra Shire Council
Kerang office Patchell Plaza, 47 Victoria Street Kerang Telephone 03 5450 9333 Fax 03 5450 3023
Cohuna office 23-25 King Edward Street Cohuna Telephone 03 5456 5222
Mail PO Box 287 Kerang VIC 3579 Email Web www.gannawarra.vic.gov.au ABN 98 993 182 937
Infringement details
Infringement type *
Parking / Animal / Livestock
Fire prevention / Local Laws / Litter
Other (please specify)
Infringement number *
Date of offence *
Vehicle registration number (if applicable)
Please list in detail your reasons for consideration (or attach a letter)
Supporting documents
Please provide any additional documents to support your application.
Acknowledgement
I understand and acknowledge that:
  • The information provided in this application is true and correct and complete to the best of my knowledge
  • This application is a legal document and penalties exist for providing false or misleading information
  • Gannawarra Shire Council may refuse this application if it becomes evident that any information or supporting documents provided is incomplete or false.

By ticking this checkbox I confirm that I have read and understood all the statements above *
Signature *  / Date *
Privacy statement
The information gathered in the form is used by Council to process the application. To view Council’s privacy policy, please visit Council offices or go to
http://www.gannawarra.vic.gov.au/privacy-statement/
Lodgement
  • in person at 47 Victoria Street Kerang or 23 King Edward Street Cohuna
  • by fax to 03 5450 3023
  • email to
  • by mail to PO Box 287 Kerang 3579

2017.07.06